Dropping of Mask Mandates in Hospitals

[bread]

How do you guys feel about this? I’m personally appalled and flabbergasted. I have young children (read: too young to wear masks), and as a physician and a parent, I can’t comprehend the reasoning behind this. Public pressure? People being tired of it? Why are we ignoring the evidence on mask efficacy? We should be protecting all patients, not to mention spreading Covid around at work will worsen staffing shortages and cause more issues with long-term disability from long-Covid issues in some people. Who is making these decisions and why do they think this is a good idea? 
 

Obviously I feel very strongly about it, but am curious to hear all perspectives (no judging, and I hope everyone can be similarly cordial!). I’m currently on parental leave and am unsure if I’m missing something here, because to me it seems like an awful idea. 

[rmorelan]

It did think the timing was a bit odd - considering we are still have outbreaks from time to time. 

Does raise the interesting question though - are we going back to the old way of doing things at some point? and if so exactly when and by what criteria? Or are we just permanently using masks continuously in all hospitals/health centres forever? At what point would you think that dropping them would work? 

What is interesting as well is that these masks don't protect just against COVID of course. I did see an up kick in the number of other resp illnesses with things started to get relaxed. I wonder if out immune systems are also a bit out of practise with the mask protections in place. 

 

 

[bread]

18 minutes ago, rmorelan said:

It did think the timing was a bit odd - considering we are still have outbreaks from time to time. 

Does raise the interesting question though - are we going back to the old way of doing things at some point? and if so exactly when and by what criteria? Or are we just permanently using masks continuously in all hospitals/health centres forever? At what point would you think that dropping them would work? 

What is interesting as well is that these masks don't protect just against COVID of course. I did see an up kick in the number of other resp illnesses with things started to get relaxed. I wonder if out immune systems are also a bit out of practise with the mask protections in place. 

 

 

For sure, I can definitely see this perspective too. I think waiting longer would be better - especially with potential for more universal vaccines on the horizon. I’m FM and before I went on parental leave, I was seeing more and more patients presenting with long-Covid issues. I myself had pregnancy complications due to Covid infection in pregnancy, despite being vaccinated. I think it also raises the question of whether we should go back to the way things were before, to begin with. Covid has taught us a lot about infection transmission in general. Masks are such a small measure to decrease risk of respiratory transmission. There was a time not long ago when gloves weren’t standard for procedures involving bodily fluids, either. 
 

My youngest child was born during pandemic times. I think about all the people who came into our room during our stay - medical staff and trainees, nurses, lab, dietary, housekeeping, etc. I would have been wildly uncomfortable had they been unmasked around our vulnerable newborn babe. It makes me think that folks taking more Covid precautions (especially if immunocompromised) will be hesitant to seek care in hospital, and that the power dynamic between patient and care team will make these patients uncomfortable asking them to mask. I guess to me, the benefits of continued masking in hospitals are >>>>> than the reasons to discontinue. 
 

Really appreciate this conversation! My parental leave bubble has definitely made me out of the loop with regards to how things are in hospital right now, so I really appreciate hearing these perspectives.  

[GH0ST]

A very interesting situation. One criticism I see regularly among our clinical colleagues is that health policy analysis is often looked at from a narrow, medicine only lens. Another challenge is that people look at the policy at face and not in the larger context of policy as a flow of processes. 

In reality, policy making, formulation, implementation, evaluation, and adoption, flow turbulently and non-uniformly in many directions 

Citation: Ontario Agency for Health Protection and Promotion (Public Health Ontario). Bergeron K. Focus On: The relevance of the stage heuristic model for developing healthy public policies. Toronto, ON: Queen’s Printer for Ontario; 2016

Even something as basic as setting an agenda is difficult to achieve in some circumstances. I often use the 4P model from Zahariadis from 2016. 

Source: Understanding Public Policy Agenda Setting Using the 4 P’s Model: Power, Perception, Potency and Proximity http://www.ncchpp.ca/docs/2020-ProcessPP-AgendaSetting.pdf 

The first step is to envision how this policy of hospital based masking even reached the agenda. As you can imagine with the pandemic, perception around masking in general are favourable (+), and the proximity of the issue is very close (+), potency would be based on the immediate impact of the policy (+), and arguments for masking is persuasive/powerful (+). It is very quick to put this into the agenda. However, as our perception of COVID-19 and masking change, so too does our society's thoughts on masking. While people can agree that masking is beneficial, more and more, people within society are willing to assume a certain level of risk tolerance. In the context of COVID-19, a combination of natural immunity + vaccination as well as COVID fatigue combined with our cultural acceptance of individualism has reduced our society's thoughts around masking in general. While one may think that more (-) means that masking policies won't make it to the agenda setting stage, it's often the reverse situation (i.e not masking) that can gain momentum. We also have to keep in mind that in this model, power is defined as our ability to persuade, which also has decreased over time for many reasons. Public health professionals in particular recognize this difficulty, which, in conjunction with other societal factors, makes it difficult to persuade society to continue masking. Hospitals are no different in this regard. 

There's still another element to remember in this policy that we haven't really reached an evaluation phase. As we evaluate a policy, we can make adjustments to then change things back. I also want to take the time to acknowledge @rmorelan's thought of "returning to normal" as we do not have the same strength of evidence for continued masking around conditions such as RSV or influenza in the same way as COVID-19, though one can criticize the limited nature of previous study quality compared to the lessons we learned now on COVID-19. Our risk perception is also warped by the fact that we do not mask often around in society any longer as public health measures relax. Combining these themes together, we have a situation where it can be hard to persuade people to continue masking consistently, limited enforcement, limited proximity and reduced perception on the importance of the issue that brings us to the development (or rescinding) of the masking policy. 

However, the policy itself is likely only for visitors or patients, which is different than staff. Occupational health and safety related policies may supercede the rescinding of mandatory masking so that staff continue to use PPE at all times. While it is less ideal, it may be a necessary compromise given the state of our society. I also think that with the years of masking, even though it will be less prevalent, there is some level of acceptance around individual decision making around mask use and that patients have the choice and are strongly encouraged to mask. We likely will see a greater % of compliance in a hospital, compared to a restaurant for example. It is also more easily normalized in a health care environment. 

There are also important considerations to the stakeholders and decision makers involved in the process. 

Source: Ontario Agency for Health Protection and Promotion (Public Health Ontario), Bray E, Bergeron K, Meserve A. Focus On: Measuring the the policy-making process. Toronto, ON: Queen’s Printer for Ontario; 2017.

We do not have all of the pictures regarding who was involved in the influencing of decisions, but I surmise that it is not only government, but hospital organizations, patient groups, allied health and physician organizations, media, policy analysts/experts, as well as many other stakeholders both internally and externally. Our perspective as physicians will differ from perspectives of politicians, or patient groups, or hospitals, etc. Notice also that the evidence-based medicine plays a smaller role here... rather, a better word to use is evidence-informed opinions, as we know evidence is often not the driver of decision making. 

----

These are just some of my immediate thoughts when contemplating the future adaption of the policy in the grand scheme of a policy cycle. It's part of the reason why there are challenges with public health professionals making a decision to either mandate vs strongly encourage masking... these decisions are not easy. The other challenge that the original poster @breadalluded to is that no matter what decision is made, many people will be dissatisfied... it's a huge conundrum in public health where a good policy is rarely recognized while public health will take blame for policies gone wrong. A difficult challenge and that's just talking about masking policies on a superficial level. Imagine how complicated it gets when we talk about vaccination policies, or school policies, etc. 

- G

 

[Intrepid86]

Mask mandates in hospitals should have ended a long time ago. Of course, anyone who stills feel compelled to wear one can still do so.